Reimbursement for surgical services has declined in recent years

In recent years reimbursement for surgical services has declined, failing to keep up with inflation and economic growth. Financial incentives aimed at re-distributing reimbursement from procedural specialties to primary care specialties have been ineffective thus far, and the financial returns of being a physician continue to decrease, according to new research published in the April 2011 issue of Otolaryngology - Head and Neck Surgery.

According to a national survey of 409 members of the general population, survey participants said that a reasonable price for a doctor to be paid for performing a tonsillectomy is $955.58, whereas the national average Medicare reimbursement is $257.74. Furthermore, 59% of respondents also believe that insurers, Medicare, and Medicaid pay doctors more than what they had input into the survey.

"The Patient Protection and Affordable Care Act of 2010 will bring many changes to the American health care system," said study author Paul Frake, MD. "More Americans will soon have health insurance, but this legislation does not include a permanent correction to the proposed spending cuts mandated under the Sustainable Growth Rate Formula (SGR) or meaningful malpractice litigation reform. As a result, physicians will face an even larger payment adjustment in January of 2012."

Physicians must continue to keep the interests of their patients at the forefront of further discussions on modernization of the American health care system. It is not clear what the ultimate economic effects of recent health care legislation will be, but greater patient education about the realities of reimbursement may aid physicians in advocating for appropriate financial consideration as health care reform continues to evolve.

Survey respondents represented 48 of the 50 states and the District of Columbia. The mean age of respondents was 35.7 years old. The average number of people per household was 2.8. Women comprised the majority of respondents at 79.7%, and men were the minority, 20.3%. With respect to health insurance coverage, 63% had health insurance, 26% had no health coverage, 5% had Medicare, 4% had Medicaid, and 2% reported "other" sources of coverage.

The study was reviewed and approved by the Institutional Review Board (IRB) of The George Washington University Medical Center and granted "IRB exempt" status due to its anonymity and minimal risk to participants.